Lisa Parker -- A Conversation with CMS Leadership on Quality, Coverage and the Patient Voice

1. www.CancerSupportCommunity.org Uniting The Wellness Community and Gilda’s Club Worldwide
Working with Regulators: A Focus on CMS
An Educational Program of the
Cancer Policy Institute at the Cancer Support Community
in Partnership with Uniting a Community (UaC):
Policy, Advocacy, Education and Action Network

2. Conditions of Participation
Clinical Standards Group
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Center for Clinical Standards &
Quality

3. What are Conditions of Participation?
Conditions of Participation (CoPs) and
Conditions for Coverage (CfCs) are health
and safety regulations which must be met
by Medicare and Medicaid-participating
providers and suppliers.
They serve to protect all individuals receiving
services from those organizations.
3INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential.
It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.

4. What are Conditions of Participation?
The CoPs help CMS ensure that all
providers and suppliers participating in the
Medicare and Medicaid programs provide
high quality care, and work towards
continued quality improvement.
4INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential.
It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.

5. Health Care Organizations & Provider Types
CMS has CoPs or CfCs for the following health
care organizations and provider types:
• Ambulatory Surgical Centers
• Community Mental Health Centers
• Comprehensive Outpatient Rehabilitation Facilities
• Critical Access Hospitals
• End-Stage Renal Disease Facilities
• Federally Qualified Health Centers
• Home Health Agencies
• Hospices
• Hospitals
5INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential.
It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.

6. Health Care Organizations & Provider Types
• Hospital Swing Beds
• Intermediate Care Facilities for the Intellectually Disabled
• Long Term Care Facilities
• Organ Procurement Organizations
• Portable X-Ray Suppliers
• Providers of Outpatient Services (physical and
occupational therapists in independent practice,
outpatient physical therapy, occupational therapy, and
speech pathology services)
• Religious Nonmedical Health Care Institutions
• Rural Health Clinics
• Transplant Centers
6INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential.
It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.

7. Revisions to the CoPs
Revisions are made to the CoPs in
response to:
• Statutory Changes
• Administration Policies and Priorities
• National Issues and Events
• Changes in Medical Practice
7INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential.
It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.

8. Examples of Current Priority Issues in CoPs
• Reduce Healthcare Acquired Conditions
• Reduce avoidable hospital readmissions
• Reduce burden on providers
• Antibiotic Stewardship
8INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly disclosed and may be privileged and confidential.
It is for internal government use only and must not be disseminated, distributed, or copied to persons not authorized to receive the information. Unauthorized disclosure
may result in prosecution to the full extent of the law.

9. www.CancerSupportCommunity.org Uniting The Wellness Community and Gilda’s Club Worldwide
9
Working with Regulators: A Focus on CMS
was made possible thanks to the support of GlaxoSmithKline